Active NPI
Soo Jin Chang, DMD
- Prosthodontics
- Los Angeles, CA
National Provider Identifier
1932611035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 62433
- Practice address
- 8501 Lincoln Blvd
Los Angeles, CA 90045-3501 - Phone
- (310) 670-1175
- NPI assigned
- Oct 30, 2017
- Last updated
- Dec 30, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 62433 | CA | Primary |
Addresses
Primary practice location
8501 Lincoln Blvd
Los Angeles, CA 90045-3501
Mailing address
702 S Serrano Ave Apt 705
Los Angeles, CA 90005-7202
Phone (213) 910-4084
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62433 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640822400000",
"number": "1932611035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 S SERRANO AVE APT 705",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900057202",
"telephone_number": "213-910-4084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8501 LINCOLN BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900453501",
"telephone_number": "310-670-1175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANG",
"first_name": "SOO",
"middle_name": "JIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-30",
"last_updated": "2021-12-30",
"certification_date": "2021-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "62433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.